Minimally invasive pancreatic surgery - a review.

Abstract

During the past 20 years the application of a minimally invasive approach to pancreatic surgery has progressively increased. Distal pancreatectomy is the most frequently performed procedure, because of the absence of a reconstructive phase. However, middle pancreatectomy and pancreatoduodenectomy have been demonstrated to be safe and feasible as well. Laparoscopic distal pancreatectomy is recognized as the gold standard treatment for small tumors of the pancreatic body-tail, with several advantages over the traditional open approach in terms of patient recovery. The surgical treatment of lesions of the pancreatic head via a minimally invasive approach is still limited to a few highly experienced surgeons, due to the very challenging resection and complex anastomoses. Middle pancreatectomy and enucleation are indicated for small and benign tumors and offer the maximum preservation of the parenchyma. The introduction of a robotic platform more than ten years ago increased the interest of many surgeons in minimally invasive treatment of pancreatic diseases. This new technology overcomes all the limitations of laparoscopic surgery, but actual benefits for the patients are still under investigation. The increased costs associated with robotic surgery are under debate too. This article presents the state of the art of minimally invasive pancreatic surgery.

Robot-assisted distal pancreatectomy: Technical aspects and results

“…К концу 2015 г. в мировой литературе было опубликовано 426 слу-чаев выполнения этой операции [13][14][15][16][17][18]. Показаниями к операции послужили нейроэндокринная опухоль (29%), протоковая аденокарцинома (23,9%), серозная или муци-нозная цистаденома (22,6%), внутрипротоковая папилляр-но-муцинозная опухоль (20%), другие заболевания (4,5%) [19][20][21][22]. Средняя продолжительность операции соста-вила 278±82,7 мин, интраоперационная кровопотеря -200±131,9 мл [14,23,24].…”

Minimally Invasive Distal Pancreatectomy: Review of the English Literature

“…The indications for LDP [5][6][7][8][9][10][11] are as follows: (1) benign, borderline, or malignant tumors of the pancreatic body and tail. The tumor should be relatively free of adhesions and easy to separate from the surrounding tissues, without distant metastasis; (2) pancreatic injury and chronic pancreatitis; and (3) pancreatitis with pseudocyst.…”

Laparoscopic pancreatic resection—a review

“…Indications for parenchyma sparing approaches include mainly neuroendocrine neoplasms, serous cystadenoma and branch duct IPMN as well as solitary renal cell carcinoma metastasis (62,65,66). Depending on the location, tumor size should not exceed 3 to 4 cm in diameter for laparoscopic EN (67,68).…”